TreatmentThis section describes the most current treatments for diarrhea. Because irinotecan is a chemotherapy drug that frequently causes diarrhea, information about that is included as well.
In general, diarrhea treatments target one or more of the following.
Many things can be done to alleviate diarrhea. Some treatments are best used preventively; others should be given only if diarrhea develops. However, good patient-provider communication may be the most important tool to prevent diarrhea. Early recognition and treatment provide the best chances for the best outcomes. That's why it's important to talk with your oncology nurse or physician about this-even if you feel embarrassed to do so.
Most HelpfulThe two treatments recommended for chemotherapy-induced diarrhea are as follows.
If radiation treatments induce diarrhea, oral opiates are recommended. They slow down the body’s ability to move stool through the intestines.
Likely to Be HelpfulOctreotide (long acting) increases the amount of time that gastrointestinal (GI) contents spend moving through the gut. When diarrhea does not respond to loperamide, octreotide often is given. Depending on the situation, long-acting octreotide can be given, with or without gradually increasing the dosage as needed. It can help treat both chemotherapy- and radiation-induced diarrhea.
Probiotics are "friendly" microorganisms (mostly bacteria) normally found in the intestine. They promote GI health by suppressing growth of "bad" microorganisms and optimizing immune responses in the gut. Probiotics also relieve irritation in the intestines. They may be used to treat or prevent diarrhea.
Psyllium fiber is a soluble fiber that absorbs water and binds intestinal contents to create more normal bowel movements. Psyllium also has anti-inflammatory properties. It may be used to treat chemotherapy- and radiation-induced diarrhea.
May or May Not Be HelpfulAmifostine selectively protects healthy tissue from chemotherapy’s cytotoxic effects. It can be used to prevent diarrhea caused by chemotherapy. This medication is given via IV with certain types of chemotherapy. Sometimes amifostine can cause a sharp drop in blood pressure.
Neomycin is an antibiotic that stops certain bacteria in the intestines from breaking down irinotecan to a much more potent compound. Taking neomycin indirectly prevents the intestines from reabsorbing irinotecan’s harmful metabolites. Some people experience side effects from taking this antibiotic.
Not Enough EvidenceOral alkalization changes the intestine's pH so that irinotecan, a chemotherapy drug, is not absorbed so much by the intestines. This, in turn, minimizes some of chemotherapy's toxic effects to the intestinal wall. This is done using a combination of medications that your healthcare provider can prescribe, including sodium bicarbonate, magnesium oxide, and ursodeoxide acid. This treatment has only been looked at in people receiving irinotecan.
Budesonide helps limit instestinal inflammation caused by chemotherapy.
Activated charcoal stops diarrhea by attracting chemotherapy toxins, which attach to the surface of the charcoal so they can be eliminated.
Cholestyramine + levofloxacin is a novel combination of drugs to prevent chemotherapy-induced diarrhea. Levofloxacin is an antibiotic that inhibits intestinal bacteria from breaking down irinotecan to a much more potent compound. Cholestyramine binds these compounds to keep them from being reabsorbed in the intestine.
Glutamine, the most prevalent amino acid in the body, is needed for many cellular functions, especially in cells that grow and divide rapidly (such as in the GI tract). Cancer treatments deplete glutamine, so replenishing it lessens GI irritation and treatment-related diarrhea.
Vitamins C and E, two key antioxidants, are depleted when diarrhea occurs. Supplementation with vitamins C and E helps decrease inflammation in the GI tract.
Deodorized tincture of opium-this agent may be helpful in treating diarrhea caused by chemotherapy.
Not Likely to Be HelpfulSulfasalazine is an anti-inflammatory drug that may provide topical relief to the inside of the intestine wall. Studies to date show that this should not be used unless the patient is enrolled in a clinical trial for pelvic radiation therapy.
Selenium, a trace mineral with antioxidant properties, may be depleted when a person has diarrhea. Little evidence exists that it may help prevent diarrhea when patients receive chemotherapy or radiation therapy.
Pentosan polysulfate (PPS), a semisynthetic anti-inflammatory, may have limited use in treating radiation-induced diarrhea.
Even though sucralfate has both healing and protective properties for other GI conditions (such as ulcers), it is not recommended for treating diarrhea because studies to date show no benefit. In addition, sucralfate may aggravate other GI symptoms.
Metabolites
breakdown products; in this discussion, specifically the breakdown products of chemotherapy agents, which can be many times more potent than their parent compounds. This increases their toxicity and the damage they can do. When they are reabsorbed into the body through the intestines, the intestines can become damaged, causing diarrhea and other symptoms.
Peristaltic
rhythmic contraction of smooth muscles throughout the digestive tract; these contractions propel food through all the digestive organs, including the intestines.
Opiate
a natural or synthetic opium derivative; the type used for treating diarrhea does not necessarily cause sleepiness
Irinotecan
a chemotherapy agent used in treating colorectal, ovarian, and lung cancer
pH
how acidic or alkaline something is. The body maintains narrow normal ranges of pH for every body fluid (e.g., urine, blood, saliva, gastric secretions, intestinal fluid).
